AccountId: 011433970860
ContactId: 21c7662e-7219-4cce-b853-d401e91899c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271489 ms
Total Talk Time (AGENT): 143457 ms
Total Talk Time (CUSTOMER): 140978 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/21c7662e-7219-4cce-b853-d401e91899c7_20250505T13:17_UTC.wav
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[AGENT][NEUTRAL] Hello, thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII], um, with Doctor [PII]'s office. I was calling, um, so we have a patient scheduled for surgery and the patient has Medicare as a primary insurance, so I was calling to see how you guys would coordinate benefits with Medicare for this patient, if you guys pick up Medicare's deductible and co-insurance.
[AGENT][NEUTRAL] What is the member's policy number?
[CUSTOMER][NEUTRAL] It is 02595732.
[AGENT][NEUTRAL] You said your name was [PII]. What is a good call back number for you just in case the call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Could you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], um, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is the gap insurance and um.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] It looks like [PII] is dependent on this policy.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So coordination, we won't coordinate with Medicare or Medicaid.
[AGENT][NEUTRAL] However, her, she has a primary insurance policy.
[CUSTOMER][NEUTRAL] Right, the primary is Medicare, right?
[AGENT][NEUTRAL] No, she's a, if her spouse has.
[AGENT][NEUTRAL] If her spouse has a primary ins if she's a dependent on this policy, that means that she has a primary insurance policy as besides Medicare and Medicaid through her spouse.
[CUSTOMER][POSITIVE] Oh yeah, yeah, I'm sorry, she has Blue Cross. I am so sorry. Yes, I'm sorry I misspoke, yeah.
[AGENT][NEUTRAL] Yes, so we will be secondary to Blue Cross.
[AGENT][NEUTRAL] So this policy is a gap insurance.
[CUSTOMER][NEUTRAL] OK, so how do you guys coordinate with Blue Cross? OK.
[AGENT][NEUTRAL] We, this policy is a gap insurance so we pay deductible, co-pay and co-insurance for services that's covered under the policy that goes towards the Blue Cross Blue Shield. What is the place of service that she's going to have services provided?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's, it's gonna be at um an ambulatory surgery center, but I'm calling for the physician, not the facility.
[AGENT][NEUTRAL] OK, but she has outpatient benefits of $6900 per calendar year, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage. However, she does have a $1000 deductible here with us at American Public Life.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So what does that mean? So until she pays that $1000 deductible um with you guys, she's, is she, so when is she not covered um up to that $1000 or?
[AGENT][NEUTRAL] No, she's covered, but we won't make start making a payment until the $1000 deductible has been met. But being that she has Blue Cross this and Medi well the third.
[CUSTOMER][NEUTRAL] She don't have Medicare, I'm sorry. Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So yeah, she will be responsible.
[CUSTOMER][NEUTRAL] No, she don't have Medicare. I'm sorry, I missed both. So, um, let me, let me understand. So she has, um, so with her Blue Cross, um, they only cover, um, up to 80%. So for the other 20%, do you guys cover that for her?
[AGENT][POSITIVE] No worries.
[AGENT][NEUTRAL] She has to meet her deductible, her yearly deductible, and she has not met it. $1000. Now if her deductible has been met.
[CUSTOMER][NEUTRAL] OK, and it's.
[CUSTOMER][NEUTRAL] How do you, how much do you guys have? Uh-huh. It's been met with Blue Cross.
[AGENT][NEUTRAL] Then we would
[AGENT][NEUTRAL] But it hasn't been met here. I'm not sure if she hasn't been submitting her claims here or not, but she definitely haven't been submitting her. I don't have any claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually, it's actually a little bit higher with Blue Cross. I don't look like it's mad, but um.
[CUSTOMER][NEUTRAL] So what do you have anything met at all on that $1000 deductible?
[AGENT][NEUTRAL] No. That's why I'm saying she, no, ma'am.
[CUSTOMER][NEUTRAL] No. OK. OK.
[AGENT][NEUTRAL] Not for 2025.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] OK, so $1000 after the $1000 deductible, then you guys pick up.
[AGENT][NEUTRAL] And we'll pay whatever went towards deductible, co-pay, and co-insurance to the Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] Rest of the deductible, the co-pay, and the co-insurance. OK, perfect. That's what I need to know. Can I get, um, uh, just a, just a reference number if I can get that.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[AGENT][NEUTRAL] We don't provide those, [PII]. However, you can use my name in today's date as a reference. It's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In today's date.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and have a great day. Thank you. You do the same. Goodbye.
[CUSTOMER][POSITIVE] Have a good day.
[CUSTOMER][NEUTRAL] Bye bye.